Baumann skin types

The Baumann Skin Type system is a classification system of 16 distinct skin syndromes for research aimed at identifying the factors that contribute to skin characteristics such as dryness, oiliness, aging, pigmentation and sensitivity. The typing system identifies various skin phenotypes for the selection of patients in clinical research and for the promotion of specific skin care ingredients and products. The classification system has been adopted by aestheticians, dermatologists, consumers and retailers to match cosmeceutical ingredients and skin care products to specific skin types.
Skin type is determined by a questionnaire, known as the Baumann Skin Type Indicator (BSTI). The 16 Baumann Skin Types have been the subject of the New York Times bestselling book The Skin Type Solution and a public television special.
The parameters
The Baumann Skin Type System is based on the identification and combination of four main skin characteristics or parameters. The BSTI questionnaire determines whether the skin is dry or oily; sensitive or resistant; pigmented or non-pigmented; and wrinkle-prone or unwrinkled (“tight”). One option from each of these parameters is assigned to the Baumann Skin Type; therefore 16 possible skin types emerge from the four skin-type parameters. For example, one Baumann Skin Type is DSPW or Dry, Sensitive, Pigmented and Wrinkle-prone while another is ORNT or Oily, Resistant, Non-Pigmented, Tight. These 16 unique skin syndromes are much more than just different combinations of basic skin characteristics. The individual parameters interact and express themselves in 16 unique syndromes that predispose certain skin types to specific dermatological issues and challenges, and dictate the courses of prevention and treatment.
Weight and severity of each parameter
Each of these four parameters is weighted to indicate the severity of each of these issues. For example, an oily skin type could be assigned a 1-4 numerical value depending on the way the questions are answered in the questionnaire; whereas the higher number indicates severe oiliness and the lower number indicates slight oiliness.
Skin Hydration: Dry (D) vs. Oily (O)
“Dry skin” is an expression that refers to skin that is a dull gray-white color, and rough in texture, and characterized by an elevated number of ridges. The role of the stratum corneum is paramount when considering dry skin. Defects in this barrier layer can lead to transepidermal water loss (TEWL). Detergents, acetone, chlorine and other chemicals, prolonged water immersion or environmental factors can also disrupt the stratum corneum. To function normally, the skin barrier must contain a proper balance of its key constituents: ceramides, fatty acids, and cholesterol. Many skin-care products target these three groups of compounds for repair. Proper diet can also increase fatty acids and cholesterol, which, in turn, can ameliorate sensitive skin. Natural moisturizing factor (NMF), derived from the breakdown of the protein filaggrin, is also a key in the dry skin puzzle as it holds water inside skin cells, leaving them plump. Filaggrin imparts structural support, and thus strength, in the lower skin layers. In the upper layers, filaggrin is broken down into NMF, which has a potent water-binding capacity. The break down of filaggrin can adjust based on environmental conditions (e.g., in a low-humidity environment, more NMF is produced, helping the skin retain water). A deficiency in NMF can lead to dry skin but does not augment skin sensitivity, as does a deficiency in the stratum corneum. Hyaluronic acid (HA) also helps the skin retain water. A deficiency of HA makes the skin look older and dehydrated but does not make skin more sensitive. Significantly low levels of HA are likely in the dry and wrinkle-prone skin syndromes such as DSNW, DRNW, DSPW and DRPW.
The level of sebaceous gland production of sebum, which contains wax esters, triglycerides, and squalene, may also contribute to dry skin and skin protection. The formation of a lipid-film from sebum-derived fats may also play a part in dry skin. It is important to note that low sebaceous gland activity has not been linked to the incidence of dry skin and the role that sebum may or may not play in dry skin etiology is not well understood. Increased sebum production, but not decreased production, is a common complaint of patients and results in oily skin, often leading to acne. Oily skin types with acne are found in these Baumann Skin phenotypes: OSPW, OSNW, OSPT or OSNT. Although diet, stress, and hormones can affect sebum production, this mechanism also has a significant genetic component, with identical twins demonstrating identical excretion rates while non-identical twins displayed significantly different ones in one study. Oily skin is found in the Baumann Skin Types OSPW, OSNW, OSPT, OSNT, ORPW, ORNW, ORPT or ORNT.
Decreased sebum production is not uncommon among people with dry skin, small pores and little history of acne. People with such skin have one of the following Baumann Skin Types: DRNW, DRPW, DRNT or DRPT. Baumann Skin Types with very dry and sensitive skin—who frequently experience erythema and pruritus probably have a defect in the stratum corneum, characterized by TEWL and a greater susceptibility to allergens, rashes and eczema. They would classify as one of the following Baumann Skin Types: DSPW, DSNW, DSPT or DSNT.
Skin sensitivity: Sensitive (S) vs. Resistant (R)
Resistant skin has a strong stratum corneum that confers protection to skin cells, keeping allergens and other irritating substances out. It rarely develops erythema unless sunburned, and rarely develops acne. Those with resistant skin can usually use any skin-care product without developing a rash, acne or a stinging sensation. However, resistant skin may also be resistant to any beneficial effects that a particular product is intended to provide.
More than 40% of people claim to have sensitive skin, with healthy, pre-menopausal women presenting with this complaint more often than other demographic groups. Finding the best skin-care product for a particular manifestation of sensitive skin is complicated by the fact that there are four very different subtypes of sensitive skin: acne subtype, rosacea subtype, stinging subtype and allergic subtype. It is important to note that inflammation is the common denominator among all sensitive skin subtypes. Sunburn susceptibility is not considered a factor in the sensitive skin designation in this skin-typing system.
Weight and severity of the sensitive skin types
A high S score on the questionnaire correlates to the likelihood that a patient falls into more than one of these subtypes. A medium score implies that a patient experiences mild symptoms of more than one subtype or significant problems associated with only one of the subtypes.
Combining dry and sensitive skin parameters
Patients with an impaired stratum corneum, manifested by dry skin, are more likely to experience allergic reactions to allergens placed on the skin. Thus, most S types that complain of frequent skin allergies also can be categorized as D types. The allergic subtype is not uncommon, with a recent UK study showing 23% of women and 13.8% of men reporting some adverse reactions to personal care products over one year, and other studies indicating that up to 10% of patch-tested dermatologic patients are allergic to at least one cosmetic product ingredient. Stinging skin is due to amplified nerve sensitivity and may be more likely to occur in dry skin types. Several tests have been developed to identify susceptible individuals. Treatments for skin of this S subtype can be tailored upon accurate testing and diagnosis, however, one must first correctly identify the exact Baumann Skin Type to ensure proper treatment. It is important to realize that all of the sensitive skin subtypes have one main mechanism in common: inflammation.
A person scoring lower on the D/O and S/R scales, characterized by slightly dry and sensitive skin, likely has an intact stratum corneum but reduced NMF and/or sebum secretion. People with slightly oily skin who fall between S and R typically have an intact skin barrier, good NMF levels and an optimal level of sebum secretion. People with OR types rarely suffer from acne. Those with slightly or very oily but sensitive skin probably suffer from acne or rosacea, but can tolerate topical treatments that DS types cannot.
Skin Pigmentation: Pigmented (P) vs. Nonpigmented (N)
This parameter measures the proclivity to develop unwanted solar induced dark patches on the face known as melasma, solar lentigos, freckles, mask of pregnancy or ephelides. These can be prevented and treated with skin-care products and procedures. Twenty-one percent of dermatologic visits consist of patients seeking such treatment. While intrinsic or genetic factors contribute to uneven pigmentation, extrinsic factors play an important role. Ultraviolet exposure increases melanosome transfer from melanocytes to keratinocytes, but avoiding or limiting UV exposure reduces the chances of altered skin pigmentation. The pigmented lesions caused by sun exposure are typically associated with other signs of skin aging such as wrinkles, so a P skin type with a significant history of sun exposure often falls into the W category.
Ephelides, or freckles, have a genetic basis, reportedly the MC1R gene, which is closely associated with fair skin and red hair. Ephelides appear early in childhood, often disappearing, at least partially, with age. People with red hair, freckles and fair skin have a higher risk of melanoma, which is even greater when associated with a history of frequent sunburns and sun exposure. Therefore the Baumann Skin Types OSPW, ORPW, DSPW and DRPW that have red hair may hypothetically be at higher risk for melanoma. Patients with ephelides clearly fall into the P category, but may be a T skin type if they have limited solar exposure and other healthy habits. Patients with darker skin tend to fall into the P categories of skin types, but many such individuals with even skin tones and no pigmented lesions are N types.
Wrinkle-prone (W) vs. Tight (T)
This parameter is affected by age and ethnicity in addition to lifestyle habits, however this is the only Baumann skin-type parameter over which an individual has significant control. That is, while a person cannot alter the genetic component of skin aging, an individual can certainly change one’s behavior to reduce the risk of incurring the signs of extrinsic aging, which is due to external factors such as smoking, excessive use of alcohol, poor nutrition, and, most importantly, sun exposure. In fact, 80 percent of facial aging is ascribed to sun exposure.
Combinations of Skin Types
While each permutation of the four skin parameters renders a skin quality with particular tendencies, certain skin-type combinations are more likely than others to develop specific cutaneous conditions or syndromes. For instance, DRPWs often have a significant history of UV exposure manifested by wrinkles and solar lentigos; DSNT, DSPT, DSPW and DSNW types are more prone than others to develop eczema; OSNT and OSPT types are more likely to suffer from acne; and OSNW and DSNW types have a greater tendency to develop rosacea.
Determining the Baumann Skin Type
The Baumann Skin Type Indicator (BSTI) questionnaire is the only validated method to determine the Baumann Skin Type. It is important to note that one’s Baumann Skin Type can change with age, pregnancy, menopause, moving to a different climate, or by changing diet or life habits. For example, a DRNW with hormonal changes and stress from pregnancy might develop acne. Her skin should be treated according to DSNW guidelines until the acne resolves. It is recommended that the BSTI be repeated annually.
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